Therapeutic and Prognostic Factors in the Management of Acute Myeloid Leukemia

The AML Cooperative Group in Germany studied the role of different intensities of induction therapy, all followed by similar postremission treatment. Of the 1034 patients of age 16–83 years. 33% were over age 60, 63% attained a complete remission, and the overall relapse-free surivival rate was 30% after 5 years. A significantly higher disease-free survival was predicted by: M3 morphology, a favorable karyotype including t(8;21), t(15;17), and inv(16); and the absence of dysmyelopoiesis. In contrast, dysmyelopoiesis; high serum lactic dehydrogenase; age over 64; and unfavorable karyotype, including abnormalities of chromosomes 5 or 7 and complex abnormalities all predicted a low relapse-free survival rate. No comparable impact on relapse-free survival was found from the two randomized different intensities of induction treatment in each age-group. Age, LDH, M3, and karyotype contributed to a prognostic index that identified good, intermediate, and poor prognostic groups. Patients older than age 60 showed significantly less frequently favorable and more frequently unfavorable karyotypes and received generally less-intensive induction treatment than younger patients did. We conclude from these results that, unlike some biologic disease characteristics, treatment variables are weak prognostic factors and high age per se may not be an independent factor of relapse-free survival.